| NPI | 1992096887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA M. ESTABROOK Executive Director 860-278-4163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 007780) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 001588) |
| 124Q00000X Dental Hygienist (Licence: CT 002904) | |
| 163W00000X Registered Nurse (Licence: CT R49289) | |
| 171100000X Acupuncturist (Licence: CT 000166) | |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: CT 031112) | |
| 261Q00000X Clinic/Center (Licence: CT 0302) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2015-11-10 |