| NPI | 1033571203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUN SONG Dentist 718-460-6868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 048211) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057991) |
| 122300000X Dentist (Licence: NY 057616) | |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2016-03-25 |