NPI | 1619061504 |
---|---|
Other Name | LLC |
Entity Type | Organization |
Authorized Contact | JOHN A DUDLEY Owner Dentist 203-426-0045 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 5576) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 8304) |
1223G0001X Dentist, General Practice (Licence: CT 9004) | |
Enumeration Date | 2006-10-03 |
Last Update Date | 2020-08-22 |