| NPI | 1558936567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONILYNN EGAN Credentialing Coordinator 718-979-2121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2021-05-21 |