| 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 |