| NPI | 1396101010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR FETOUH Owner 716-348-9855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 24314) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30316) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2016-01-11 |