| NPI | 1114160207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER H PRUDEN Oral Surgeon 631-421-2471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 034661) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2009-04-20 |