| NPI | 1619249059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX MONTAZEM Doctor/Owner 631-265-9700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 042730) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2016-11-30 |