| NPI | 1124521646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AAKASH C MUDALIAR Vice President 570-309-8223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS038564) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: PA DS041461) |
| Enumeration Date | 2018-03-11 |
| Last Update Date | 2018-03-11 |