Individual
MARK SAMUELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
88 RYDERS LN, STRATFORD, CT 06614-1666
(203) 378-1566
(203) 380-8390
Mailing address
88 RYDERS LN, STRATFORD, CT 06614-1666
(203) 378-1566
(203) 380-8390
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6758
CT
Other
Enumeration date
04/02/2007
Last updated
04/04/2014
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