| NPI | 1316793102 |
|---|---|
| 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 | 2024-04-24 |
| Last Update Date | 2024-04-24 |