| NPI | 1770745242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RON ARBUCKLE President 860-728-6668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 7628) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 9050) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2008-06-26 |