| NPI | 1144364639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX GARDNER WADE Dentist 917-657-5233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5527) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2020-08-22 |