| NPI | 1255600334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY D. HACK Associate Professor 410-707-7047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MD 7967) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MD 07967) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2011-12-20 |