| NPI | 1760780621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY KEARNS Practice Coordinator 631-421-2544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 044656) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 041527) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 052978) | |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2011-03-02 |