| NPI | 1619171790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMMAR IDLIBI Owner 860-584-0441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 7893) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CT 6903) |
| 1223G0001X Dentist, General Practice (Licence: CT 10813) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 008462) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 10740) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2013-07-03 |