| NPI | 1932499274 |
|---|---|
| Doing Business As | KIPS BAYS BOYS AND GIRLS CLUB/CREST SMILE SHOPPE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | SAMUEL DELEON VP Medical Affairs/Cmo 718-589-2440 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2011-04-07 |