| NPI | 1861762635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LONNIE LAGASSE Office Manager 860-523-6549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 004732) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-02-17 |