| NPI | 1124379920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLENE J. KELLEY Office Manager 607-432-3564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2012-09-20 |