| NPI | 1790068500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONI L RUSSO Owner 860-749-6622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 010105) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2011-09-28 |