| NPI | 1154761138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT C DICKINSON Owner 315-454-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28860) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2013-07-19 |