| NPI | 1013189349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN D BLANC Secretary 814-833-1131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA ds036140) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2008-03-26 |