| NPI | 1316075583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH A HOLLY Owner 607-757-0455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 0369901) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2008-02-11 |