| NPI | 1811874464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEIGH ALEX Owner 631-839-0052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-08-18 |
| Last Update Date | 2025-08-18 |