| NPI | 1023174554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW DEAN GRUVER President 410-766-2744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 7170) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 13735) |
| 1223E0200X Dentist, Endodontics (Licence: MD 5755) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-08-22 |