| NPI | 1164787636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT DALLMANN Billing Manager 212-206-6465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 252964) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-10 |