| NPI | 1093916702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRELL ADRIAN CLARK President 301-218-1622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MD 8308) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2011-07-12 |