Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 008040 | CT |
NPI | 1093782476 |
---|---|
Provider Name | Dr. Annmarie Delessio-Matta |
First Address | Southbury, CT 06488-2295 |
Second Address | Southbury, CT 06488-2295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 08/07/2007 |