| NPI | 1053538496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES HAYNES President 410-641-3490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 5914) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |