| NPI | 1194191619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALVIN CHRISTOPHER MIRANDA Owner 410-420-9705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 13020) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15773) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |