| NPI | 1790235919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT C DICKINSON Owner 315-454-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3846-16) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2016-10-12 |