| NPI | 1881670883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN RICHARD KREITZBERG President 631-543-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 036804) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2013-07-10 |