| NPI | 1629366703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESIREE LARACUENTE Owner 718-478-2825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 053544) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2011-07-11 |