| NPI | 1760416176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM RUSH Chief Financial Officer 860-822-4153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CT 0299) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 0299) |
| 124Q00000X Dental Hygienist (Licence: CT 0299) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-07-03 |