| NPI | 1790124949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGES TRABOULSI President 860-558-7141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401413344) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2013-06-20 |