| NPI | 1598919664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN JIMENEZ Business Owner 718-299-2972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 046812-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 033591-1) |
| 1223G0001X Dentist, General Practice (Licence: NY 053179-1) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 054040-1) | |
| Enumeration Date | 2008-11-15 |
| Last Update Date | 2008-11-15 |