| NPI | 1740756345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE LO Dentist 860-563-3330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2018-10-22 |