| NPI | 1376799510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARANAK BALAZADEH Dentist 718-544-4440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2008-08-07 |