| NPI | 1336659721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYSON BROSS Principal 443-373-1634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 14024) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2017-10-11 |