| NPI | 1649573197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD SHALOMOV Dentist/President 718-523-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 054092) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2010-12-06 |