| NPI | 1124264866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN J REAVES Owner General Dentist 315-736-0139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 053015) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: NY 032955) |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2014-11-05 |