| NPI | 1720409303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANATOLIY KONOVALOV President 718-975-4475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 054967) |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2013-12-26 |