| NPI | 1578788576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRIGORIY YUSUPOV Dds General Dentist 908-527-8688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22D102207500) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |