| NPI | 1699168757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD MICHAEL LAGUARDIA Member 631-360-1544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 048499) |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2015-03-13 |