Facts
- Status
- A
- Credential
- DDS
- Type
- Individual
- Enumeration date
- 2019-01-28
- Last updated
- 2026-02-19
Licenses
- License CT
- CT12435
Location
- Practice location
- 44 DALE RD
- City
- AVON CT
- Postal code
- 060014315
- Phone
- 860-674-8417
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.