| NPI | 1205974680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK T BALONEK President 585-426-3050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 041559) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2013-06-17 |