| NPI | 1811258627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE ELVIS CALDERON Dentist 631-666-1392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 045-794) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2021-05-06 |