| NPI | 1174637185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON KEITH ELLIS Pres/Owner 301-739-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 12508) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14739) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2017-11-08 |