| NPI | 1376737288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUDELLA SAN JUAN LICAROS Dentist 212-787-2749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: NY 043676) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2007-09-04 |