| NPI | 1154439719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS CLARK Business Manager 215-536-1562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS026801L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS035697) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2014-10-17 |