| NPI | 1366617250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT BAVISOTTO Orthodontist 716-649-5254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 0321781) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2009-11-03 |