| NPI | 1811739832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROMAN L AKILOV President 917-533-0043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-06-10 |