| NPI | 1750434809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES J PTAK President 718-383-0933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 0522391) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 034744) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2020-08-22 |