| NPI | 1134464936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IMAN SHAHINE Owner 315-622-6603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 051526) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056220) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2012-12-05 |