| NPI | 1548558836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIA DATIKASHVILI President 646-404-5005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 055422-1) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2011-07-20 |