| NPI | 1518410281 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL WIEDER President 516-316-4480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 058348-1) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2016-07-29 |