| NPI | 1720204415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERENCE E HICKEY President 203-755-5641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 5521) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 4391) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2012-05-10 |