| NPI | 1528488194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLON MOORE President 718-828-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: NY 045968) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2014-04-22 |