| NPI | 1083004519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA MARIE MATTSON Dentist 443-394-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13433) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2015-02-04 |