| NPI | 1124832670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE FERNANDO Regional Manager 443-252-4229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-02-05 |