| NPI | 1184139669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT HENRY CARLSON Owner 856-507-9732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22D102696200) |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2017-12-06 |