| NPI | 1902562697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELESTE MCDONALD Owner 917-274-7599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2021-11-17 |