| NPI | 1407118540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL IOANNOU Pediatric Dentist 631-486-6364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 050315) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053854-1) |
| 122300000X Dentist (Licence: NY 054175) | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2012-06-14 |