| NPI | 1598447328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD WOODBINE Owner 718-652-3699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 261QA1903X Clinic/Center Ambulatory Surgical |
| 261QS0112X Clinic/Center Oral and Maxillofacial Surgery | |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-08-02 |