| NPI | 1598418832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JACKSON Dentist 718-446-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-01-27 |