| NPI | 1215390992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY CHASE Member 631-393-6888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 32187) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-03-31 |