| NPI | 1992871628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD JAY RISINGER Secretary 860-633-8321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2020-08-22 |