| NPI | 1376693697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL T FALLON Owner 315-451-6988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 026188) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-10-19 |