| NPI | 1619405412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER VOLCHONOK Owner 929-293-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 50058006) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2022-07-21 |