Individual
MIRINAE BAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
450 S MAIN ST, NEW BRITAIN, CT 06051-3551
(860) 223-2424
Mailing address
53 CLOVE BRANCH RD, HOPEWELL JUNCTION, NY 12533-5221
(845) 242-3132
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
010588
CT
Other
Enumeration date
07/21/2011
Last updated
07/21/2011
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