| NPI | 1205321304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA C FAN Owner/Member 516-382-4789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 051937-1) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2018-06-30 |