| NPI | 1215940150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELVYN ARNOLD BLAKE Owner 856-596-1460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI00895300NJ) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-22 |