| NPI | 1548434095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL S BROOKSTONE President Owner 516-826-1666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 042202) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2008-04-16 |