| NPI | 1912035213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA D FABIAN Practice Manager 203-874-1664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2013-04-18 |