| NPI | 1164577268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD COPELL Director 718-260-9293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 035548) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |