| NPI | 1891295861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER C SULLIVAN Periodontist/Owner 646-808-9088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MN S125) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-02-16 |