| NPI | 1669894325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMAN SOURI President 917-701-3581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS038427) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-01-15 |