Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 7884 | CT |
NPI | 1104048016 |
---|---|
Provider Name | Dr. Andrea Gentile-Fiori |
First Address | Meriden, CT 06450-6600 |
Second Address | Meriden, CT 06450-6600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |