| NPI | 1760693006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARMAINE ANDREA EVANS President 718-703-8496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 044715) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-08-22 |