| NPI | 1346790813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID TAVELIN Sole Member 917-309-3961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: NY 50111243) |
| Enumeration Date | 2016-10-09 |
| Last Update Date | 2016-10-09 |