| NPI | 1548992738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY MAZZARELLI Authorized Official 516-593-1380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| 1223D0004X Dentist Dentist Anesthesiologist | |
| 1223G0001X Dentist General Practice | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2022-06-27 |