Organization
ENDODONTIC SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANISLAV MOLINE DMD, MDS (MANAGER)
(860) 000-0000
Entity
Organization
Contact information
Practice address
2 CHUCRH ST # 670, ELLINGTON, CT 06029-0670
(860) 000-0000
Mailing address
PO BOX 670, ELLINGTON, CT 06029-0670
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
9473
CT
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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