| NPI | 1205972650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAVID KORNGOLD Partner 718-252-8989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 35130) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 32364) |
| 1223P0300X Dentist, Periodontics (Licence: NY 42509) | |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 30118) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 43380) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-08-22 |