| NPI | 1821838772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE HAMILTON Director, Provider Strategy 315-410-5531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-05-29 |