| NPI | 1194890418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY L. CROYLE Secretary/Ins. Billing 814-269-4404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS021727L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS023637L) |
| 122300000X Dentist (Licence: PA DS021727L) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2012-03-29 |