| NPI | 1831905801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAGGIE MCCLAIN Operations And Transitions Manager 860-269-0628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-12-05 |
| Last Update Date | 2024-12-23 |