| NPI | 1346624038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE HARRIMAN Director Of Business Operations 267-668-8001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2017-03-13 |