| NPI | 1558691972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETALROSE WENHAM-CLARK Practice Owner 518-218-7792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 045037-1) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2010-01-07 |