| NPI | 1598433971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANU NELLISSERY Member 860-688-6030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2021-09-01 |