| NPI | 1962177550 |
|---|---|
| Doing Business As | 103 DENTAL |
| Entity Type | Organization |
| Authorized Contact | JOSE LADINO Dentist 917-854-5645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2021-08-16 |