| NPI | 1437303054 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | GEORGINA M LOPEZ Dentist 718-672-6656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 042653) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2008-11-10 |