| NPI | 1275677452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK RICHARD MINICHELLI President 814-833-4393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS027249L) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2020-08-22 |