| NPI | 1700179124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOSES DATSON Owner 212-660-0305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 047288) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2024-07-09 |