NPI | 1275389223 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHELLE JACOMINO-BARNES Dir. Credentialing And Enrollment 315-454-6000 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2024-04-29 |
Last Update Date | 2024-04-29 |