| NPI | 1356644512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE ALSOP Financial Manager 301-345-2880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 13883) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 6317) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 12653) | |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2010-12-09 |