| NPI | 1770705766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC BAUM President 631-751-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 046703) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 047430) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 048062) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2008-02-20 |