| NPI | 1679360051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER L FREEBERN Financial/Insurance COO Rdinator 518-584-2044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2025-04-21 |