NPI | 1417316985 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHN MICHAEL FOX Owner 518-725-4216 |
Organization Subpart ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 057295) |
Enumeration Date | 2016-02-12 |
Last Update Date | 2016-02-12 |