| NPI | 1053607002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE M MCCABE Office Manager 301-862-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 6466) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14501) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2011-06-28 |