| NPI | 1356465298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEERAWEE UNCHALIPONGSE Manager 718-596-5537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 0484571) |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2012-02-24 |