| NPI | 1790149045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW EVERETT President 631-689-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 054294) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2016-04-12 |