| NPI | 1003306671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BYRON CHARLES DESBORDES Owner 410-623-7381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 12002) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2021-02-02 |