| NPI | 1356354708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOU ANN VANDERWENDE Patient Account Coordinator 302-678-3652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2008-04-20 |