| NPI | 1265571426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS JEROME FEDORKA Owner Oral & Maxillofacial Surgeon 814-336-3357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DS023205L) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-10-02 |