| NPI | 1720250558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUBEN FATTAKHOV Dentist 718-760-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 046847) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2008-04-01 |