| NPI | 1790271641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES CHU-WEN FANG Owner 646-643-3178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22D102454800) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2018-07-03 |