| NPI | 1225455116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATYANA AVDEYCHIK Dentist 718-646-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 044215) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 044239) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |