| NPI | 1154675304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SRINIVASULU KAKOLLU President 732-379-0953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-028401) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |