| NPI | 1508698556 |
|---|---|
| Doing Business As | ALTA DENTAL LLC |
| Entity Type | Organization |
| Authorized Contact | ALTAY KHANMAMEDOV Owner/Provider 917-881-5977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-08-19 |