| NPI | 1093295735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN CISTERNAS President 917-414-4993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 059157) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 029974) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 049017) | |
| 1223G0001X Dentist General Practice (Licence: NY 052816) | |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2018-08-21 |