| NPI | 1356457394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH R. SIVA President 718-428-2626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 36722) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |