| NPI | 1326180324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIA LYNN KOONTZ Office Manager 443-512-8703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 10773) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-08-22 |