| 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 |