| NPI | 1003012030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID RUSSELL STASIAK Owner 716-681-5468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 037584) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2007-10-02 |