| NPI | 1376268821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARLENE BRONSTORPH Director 516-850-3999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2023-06-05 |