| NPI | 1508254145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM VAN CAMP Provider Relations Specialist 315-464-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 15671) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2015-01-06 |