Provider First Line Business Practice Location Address:
587 ELM ST
Provider Second Line Business Practice Location Address:
SHIPPAN DENTAL CENTER
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06902-5113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-658-8797
Provider Business Practice Location Address Fax Number:
203-355-9837
Provider Enumeration Date:
12/18/2012