| NPI | 1295097699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD F. BLACK Owner 570-724-2141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: PA DS025700L) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2012-06-12 |