| NPI | 1265721534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL HENRY DETOLLA President 603-436-3608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2011-04-07 |