| NPI | 1528189545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE GREGORY DAVIS Co Owner 518-383-3960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY ny041715) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY NY041746) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |