| NPI | 1902053531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT J. MAILLOUX Owner 860-247-1021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 5868) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2011-07-05 |