| NPI | 1861944043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIOT LUTZ Vice President 347-244-2914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 057648) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: NY 057524) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-11-03 |