| NPI | 1861664369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ROGER MARCOTTE President 860-589-3316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 4301) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |