| NPI | 1891544102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN EATMON Medical Director 631-374-3410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2024-05-17 |