| NPI | 1720520976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAUSHAD EDIBAM Member 203-325-2661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CT 009711) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2016-11-04 |