| NPI | 1891135109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD J BAILEY Manager 203-481-3973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 5366) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CT 5366) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2013-07-01 |