| NPI | 1386195600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HECTOR PENA Owner 516-600-9145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 050912) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 050779) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 053544) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 050779) | |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |