| NPI | 1124308184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK AGABABAEV President 718-887-1397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010091) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2011-08-23 |