| NPI | 1013061563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE CHRISTINE COLLIVER Business Manager 301-662-5914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 9614) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-08-22 |