| NPI | 1649482324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN VAN LEW Office Manager 860-691-0025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 9420) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2009-09-25 |