| NPI | 1710394903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | POLINA P SIMANOVICH Dentist/Prosthodontist 203-235-1415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CT 10452) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2014-07-19 |
| Last Update Date | 2023-05-03 |