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Organization
MYSTIC DENTAL GROUP, P.C.
Active
Organization
MYSTIC DENTAL GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA CISCO (MANAGER)
(860) 536-4951
Entity
Organization
Contact information
Practice address
117 COW HILL RD, MYSTIC, CT 06355-1449
(860) 536-4951
Mailing address
117 COW HILL RD, MYSTIC, CT 06355-1449
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8531
CT
Other
Enumeration date
05/21/2008
Last updated
05/21/2008
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