| NPI | 1093220105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVONNE KAY KIRKLAND Office Manager 717-248-4896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: PA DS017307L) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: PA DS021903L) |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2018-06-16 |