| NPI | 1255724878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRANDA KRIVCA Dental General Practice Resident 347-209-4779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2015-10-24 |