| NPI | 1871709097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZ ANN JERMYN Office Manager 631-924-8155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology |
| 1223P0300X Dentist Periodontics | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-08-31 |