| NPI | 1184779985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALYA KONDRATYEVA Owner 856-963-0315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS 029186-L) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2021-01-19 |