| NPI | 1629301395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON R GORDON Dentist/Owner 347-281-9444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 0528121) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |