| NPI | 1326186743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY M GORDON Vice President 717-637-0202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA 24985) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA 36615) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: PA 28116) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: PA 22314) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2011-02-04 |