| NPI | 1356441612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANCIS A FORMICA Tres 301-262-3535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 03909) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 04017) |
| 122300000X Dentist (Licence: MD 04497) | |
| 122300000X Dentist (Licence: MD 12848) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-08-22 |