| NPI | 1174694251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN B. MASTELLA Owner 410-628-1818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 9384) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2020-08-22 |