| NPI | 1326802190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BECKY FIZZ Admin Manager 610-401-0559 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-02-19 |