| NPI | 1164921292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EKATERINA TOMENKO Owner 301-439-8333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MD 14794) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14794) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2021-09-28 |