| NPI | 1366614455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VLADIMIR A POTEPALOV Dentist 718-368-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NY 051368) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2008-03-28 |