| NPI | 1205977147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALIA TARASEVICH Owner 315-732-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 050599) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |