| NPI | 1013211226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN B GOLDSTEIN Owner 716-632-2545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 0494591) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 053977) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2011-01-03 |