| NPI | 1326587783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOO JIN SHIN Member 347-563-5530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CT 11353) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CT 11350) |
| Enumeration Date | 2017-02-18 |
| Last Update Date | 2017-02-18 |