| NPI | 1093028169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR FETOUH Orthodontist 716-348-9855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 24313) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2010-07-19 |