| NPI | 1174858419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID A. MACGREGOR Owner 315-343-6160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 051594) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2019-01-31 |