| NPI | 1093915357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUSTAFA MORRIS Credentialing Specialist 202-715-6590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2024-01-31 |