| NPI | 1265585046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA FAGIOLETTI Dentist 302-366-8668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DE 2005207645) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |