| NPI | 1629580741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAQUEL ROZDOLSKI Owner 917-903-1630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 001162) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056669) |
| 122300000X Dentist (Licence: CT 11448) | |
| 122300000X Dentist (Licence: MA DN1857802) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CT 8494) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MA DN2228213-A) | |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2017-10-30 |