| NPI | 1710275987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN KETOVER Dentist 718-168-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 035400) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-07-21 |