| NPI | 1588962971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARA MIKHAIL Dds, Provider 631-835-0569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 054016) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2011-03-08 |