| NPI | 1063628832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLY SAMUEL Office Manager 718-471-3366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 02631267) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2009-12-23 |