| NPI | 1104422377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE ALONZO CHAPMAN Billing And Revenue Mgr. 443-739-3253 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2023-10-04 |