| NPI | 1033564315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HRISTOS RISTAS VP Of Contracting 215-955-9298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2022-10-14 |