| NPI | 1629403217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DIXON Owner 860-651-9568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 010256) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2013-09-13 |