| NPI | 1790078418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK AGABABAEV Vice President 718-887-1397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 010091) |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2011-05-27 |