| NPI | 1184915415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELINA SANTA MARIA Business/Finance Manager 315-214-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 051925-1) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2011-04-20 |