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GWENDOLYN BASILICA RDH

>> Dental Hygienist >> Dental Providers

Registrant NPI Number: 1588652697

Individual Registrant:
 GWENDOLYN  BASILICA RDH
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1 SHAWS CV  NEW LONDON, CT 06320-4902 US
Tel: 860-444-0498  Fax: --

Contact information for business:
54 GARDNER AVE  NEW LONDON, CT 06320-4313 US
Tel: --  Fax: --

Registration Information:
NPI: 1588652697
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y124Q00000XDental Providers
Dental Hygienist
CT002820

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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