| NPI | 1689816274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON H DAVIS Owner 518-563-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 047679-1) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2024-04-29 |