| NPI | 1568600757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER GRANNUM Chief Executive Officer 917-816-0481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 052633) |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2011-09-29 |