| NPI | 1437899812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUMAN KISHORE KONDRAGUNTA Member 347-631-0848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2023-09-14 |