| NPI | 1043863186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JO ANN RICE Credentialing Director 609-315-3851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2023-10-12 |