| NPI | 1285079962 |
|---|---|
| Other Name | GLENDALE BOUTIQUE DENTAL |
| Entity Type | Organization |
| Authorized Contact | YELENA M MULLAKANDOVA Owner/Dentist 917-640-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 055256) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2014-07-19 |