| NPI | 1649618901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES BUSSIERE Owner 860-404-5494 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 7753) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CT 7753) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2013-06-10 |