| NPI | 1992841449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS KRASNOV Administrator 212-631-0222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 046043) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 050148) |
| 1223G0001X Dentist General Practice (Licence: NY 046686) | |
| 1223G0001X Dentist General Practice (Licence: NY 052674) | |
| 1223P0300X Dentist Periodontics (Licence: NY 042707) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 050706) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-08-22 |