| NPI | 1346300209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD ROBISON Treasurer 315-637-6961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 027300) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 043434) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 038405) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 050957) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |