| NPI | 1164464848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD R DELUKE, Director 518-374-4118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 030136) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2020-08-22 |