| NPI | 1922748177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE ROCKLIN Credentialing Specialist 518-867-5073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-03-29 |