| NPI | 1619362571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD SHUKOVSKY Owner 203-348-2411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 005762) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2015-03-30 |