| NPI | 1124115373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA M DUVAL Office Manager 518-372-2859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 034224) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 044618) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2008-07-02 |