| NPI | 1508196890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE J. MANTEL Dentist 718-641-1333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2010-01-08 |