| NPI | 1073897609 |
|---|---|
| Doing Business As | UPPER WESTSIDE DEANTAL |
| Entity Type | Organization |
| Authorized Contact | BENJAMIN BANNEKER SHIRLEY Dentist 917-667-6015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 0543381) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2011-09-30 |