| NPI | 1164974846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN CORMAC MACDERMONTT Owner 718-855-2855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 052448) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 054412) |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2016-10-28 |