| NPI | 1639196637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE L WHITACRE Office Manager 518-583-4497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2014-09-04 |