| NPI | 1124220454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDRICK J TISOT Partner 856-428-8822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DIO1202700) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |