| NPI | 1790110021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY WILLIAM RAY Oral Surgeon 518-562-1020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 056610) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2013-09-05 |