| NPI | 1720201205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JEROME LEE Vice President 607-754-1999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 046853-1) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 047633-1) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2011-05-02 |