| NPI | 1861664864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL HENNIS Dentist 631-748-6136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 037149) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 041974) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2008-03-31 |