| NPI | 1679684757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY A TOBACK President 860-443-5298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 8455) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: RI 2628) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-02-22 |