| NPI | 1194911693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD ALAN ETENGOFF President Orthodontist 716-877-5941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 0320981) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2007-09-18 |