| NPI | 1740794569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT A BRADFORD President 315-882-5042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NY 048823) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 048823) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2017-12-01 |