| NPI | 1245355312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BASTACKY Doctor Owner 410-744-4222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 10337) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2008-04-20 |