| NPI | 1982759791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS B. KECK Owner 203-787-3669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 9409) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 5525) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 7814) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-08-22 |