| NPI | 1194929596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ROBERT BOURQUE President 716-693-1971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 37469) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2010-06-01 |