| NPI | 1255471157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON WILLIAM POWELL Owner 410-695-5695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410627) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2010-01-20 |