| NPI | 1699372391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS SHANNON Dds 860-481-7631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |