| NPI | 1720004344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RONALD VIVIANI Owner 631-424-3838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 040407) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-08-22 |