NPI | 1184436743 |
---|---|
Entity Type | Organization |
Authorized Contact | CHRISTINE BARBER Provider Enrollment Team Lead 315-454-6000 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2025-01-22 |
Last Update Date | 2025-01-22 |