| NPI | 1053084376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARMIE WILEY Financial Coordinato 315-336-6380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2021-08-02 |