NPI | 1073788717 |
---|---|
Entity Type | Organization |
Authorized Contact | JAMES M WALLETT General Dentist/Owner 718-748-6847 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 036639) |
Enumeration Date | 2008-04-24 |
Last Update Date | 2008-04-24 |