| NPI | 1447298070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALI GACHE CFO 718-240-1795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality | |
| 1223E0200X Dentist, Endodontics | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2019-04-03 |