| NPI | 1891970166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERALYN R FANTARELLA Owner 203-288-4855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 7613) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2008-01-07 |