| NPI | 1497289037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL PROOTHI Owner 631-675-9601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 051735-1) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2024-02-29 |