| NPI | 1083230494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN GOLEBURN Partner 302-836-3750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2020-06-22 |