| NPI | 1437690104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER KRAUSHAAR Provider Relations 315-454-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019027575) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-03-15 |