| NPI | 1205709458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS KAYLAKOV President 929-900-2197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| 1223E0200X Dentist, Endodontics | |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2025-09-24 |
| Last Update Date | 2025-09-24 |