| NPI | 1083027197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HALEH BAZARGAN Owner 631-388-0906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 8563) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 2553) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 8377) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2014-06-05 |