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Individual
OAK GAR MOE
Active
Individual
OAK GAR MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2.014402
CT
1223G0001X
General Practice Dentistry
DN10000929
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/15/2025
Last updated
07/01/2025
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