| NPI | 1114417045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL KELLY Gm 717-925-4327 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: PA DS025788l) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: PA ds035577) |
| 261QD0000X Clinic/Center, Dental (Licence: PA ds040000) | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2018-05-16 |