| NPI | 1609538388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENAN BUITRAGO President 917-574-3822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 1223P0700X Dentist, Prosthodontics | |
| Enumeration Date | 2021-10-09 |
| Last Update Date | 2021-10-09 |