| NPI | 1932554425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM VAN CAMP Provider Relations Specialist 315-454-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN21028) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2016-05-03 |