| NPI | 1871863613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TETYANA POHORLETSKA Officer 203-517-9507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010053) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |