| NPI | 1790900785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRIGORIY YUSUPOV Dds General Dentist 718-421-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 049312) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |