| NPI | 1639761646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALYA KOROBEYNYK Rcm 516-654-4400 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2023-02-21 |