| NPI | 1649043910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLAS MICHAEL FREDA Owner 607-953-4797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2023-10-31 |