| NPI | 1154374676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILIO ENRIQUE RIVERA President 410-799-2692 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 7902) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 8363) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-08-22 |