| NPI | 1194980466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA JUDD Office Manager 631-669-0261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 41623) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 037779) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2008-07-25 |