| NPI | 1093267866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE SWEGER Financial / Insurance Coordinator 315-460-6491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2016-10-27 |