| Organization Name: | FEDORCIW AND MASSOUMI LLC |
| NPI Number: | 1396866927 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MEHRAN MASSOUMI (OWNER) |
| Mailing Address: | 26 Shunpike Rd Cromwell |
| State: | CT US |
| Postal Code: | 064162442 |
| Phone Number: | 8606354666 |
| Fax Number: | 8606353621 |
| NPI Enumeration Date: | 04/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 8806 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |