Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 3871 | CT |
NPI | 1043246671 |
---|---|
Provider Name | Dr. Stanley Pearlson |
First Address | Manchester, CT 06040-4445 |
Second Address | Manchester, CT 06040-4445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 08/07/2007 |