| NPI | 1841486610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSTISLAV KRASNOV Owner 860-676-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 008698) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2015-04-07 |