| NPI | 1730109133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDOUARD ETLIS President 718-769-5379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 047627) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |