| NPI | 1225574577 |
|---|---|
| Doing Business As | DR. MICKEY'S PEDIATRIC AND ORTHODONTIC SPECIALISTS |
| Entity Type | Organization |
| Authorized Contact | PUSHPAK PATEL President 857-919-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MA DN1855141) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855141) |
| 124Q00000X Dental Hygienist (Licence: MA DN1855141) | |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2017-01-10 |