| NPI | 1760609275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN J. MARIE Pres. 718-317-8524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 040958) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2012-11-13 |