| NPI | 1184896912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERTHA DINA BRAVO Dentist 516-933-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 044278) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2021-02-03 |