| NPI | 1104398510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN GALLAGHER Insurance Coordinator 484-821-1357 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2018-12-24 |
| Last Update Date | 2018-12-24 |