| NPI | 1609954064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARISA ILYUTOVICH President Owner 201-346-4660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI020299) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-08-22 |