| NPI | 1073279832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH ALBANESE Partial Owner 718-987-6543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223P0300X Dentist Periodontics | |
| 124Q00000X Dental Hygienist | |
| 204E00000X Oral & Maxillofacial Surgery | |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2021-11-16 |