| NPI | 1255504148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA CHICO CORNEJO Owner 301-947-5300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 11898) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2008-04-11 |