| NPI | 1750696399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKSON MENDES Vice President 203-663-2772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 008314) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 10567) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2013-05-09 |