| NPI | 1720829732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYANNE KEATING Office Manager 315-253-7384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2024-06-04 |
| Last Update Date | 2024-06-04 |