| NPI | 1407941685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STUART R DOUGLAS Owner Dentist 607-753-0602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 029842) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052962) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |