| NPI | 1518297852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALTAY KHANMAMEDOV Owner/Manager 917-881-5977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 051162) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2010-01-08 |