| NPI | 1174063440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOSHUA SHAFFER Member Dentist 516-660-9341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 056871) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056951) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2017-03-06 |