| NPI | 1003338674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLGA MIHNYONOK Officer 718-963-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2022-07-21 |