| NPI | 1225272610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERTO GARCIA Billing Clerk 315-531-9102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 42164) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 36750) |
| 122300000X Dentist (Licence: NY 42795) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-04-29 |