| NPI | 1568951457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELINA BLANKSCHEN Administrator 860-997-0569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NH 03561) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2018-05-07 |