Organization
GRACE TYLO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE LO (DENTIST)
(860) 563-3330
Entity
Organization
Contact information
Practice address
35 COLD SPRING RD STE 324, ROCKY HILL, CT 06067-3163
(860) 563-3330
(860) 563-3058
Mailing address
35 COLD SPRING RD, ROCKY HILL, CT 06067-3160
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
Other
Enumeration date
10/22/2018
Last updated
10/22/2018
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