| NPI | 1801196134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE LYNN DENNIS Book Keeper 518-817-2490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 052845) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 022051-1) |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2018-03-17 |