| NPI | 1255115598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA QUINTEROS Credentialing 724-901-1964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| Enumeration Date | 2023-08-18 |
| Last Update Date | 2024-01-25 |