| NPI | 1518242320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANUEL GOODLOE Owner 716-626-0001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 044038) |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2011-10-13 |