| 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 |