| NPI | 1760431621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASMA IJAZ Owner 203-234-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 9252) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 9252) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 10478) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CT 9252) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 9252) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 9252) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2015-03-03 |