Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 009105 | CT |
NPI | 1053587592 |
---|---|
Provider Name | Dr. Philip Ralph Mascia |
First Address | Brookfield, CT 06804-2406 |
Second Address | Brookfield, CT 06804-2426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 14/09/2016 |