| NPI | 1639570278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTOINE J PANOSSIAN Owner/Surgeon 718-497-9700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 052799) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 051170-1) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 049449-1) | |
| 125J00000X Dental Therapist (Licence: NY 052602) | |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2014-09-15 |