| NPI | 1215055314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN ELIZABETH POLEON Dentist 716-909-1470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 050613-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 053052-1) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-08-22 |