| NPI | 1720112212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER FREEBERN Financial Coordinator 518-584-2044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 027425-1) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-08-22 |