| NPI | 1649813783 |
|---|---|
| Doing Business As | AVON DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | LEAH ANN MAYLOTT Credentialing Administrator 860-874-8198 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2022-01-17 |