| NPI | 1609278233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL KUNCIO Member 718-850-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 051019) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: NY 051019) |
| 126800000X Dental Assistant (Licence: NY 051019) | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2015-07-07 |