| NPI | 1063718435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT FATAKHOV Dentist 917-291-4232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 054434) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 051345) |
| 122300000X Dentist (Licence: NY 053061) | |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2011-02-02 |