| NPI | 1730440587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATRINA MIDDLETON Biller 718-671-2826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 055124) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: NY 052905) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2012-06-07 |