| NPI | 1053538116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY M. SHUPIK Periodontist 856-428-4746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI00971800) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2011-10-18 |