| NPI | 1275751802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VASUKI THEVANAYAGAM President 716-568-1163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 049037) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-08-22 |