| NPI | 1285414391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELINA FAGAN Financial Supervisor/Manager 215-707-2828 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223E0200X Dentist Endodontics | |
| 1223P0300X Dentist Periodontics | |
| 1223P0700X Dentist Prosthodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |