| NPI | 1194949214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLA KUSH PROKOP Pediatric Dentist 410-897-1931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 12877) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |