| NPI | 1356714448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED AYES Operations Manager 267-774-5629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS019126L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS019126L) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2015-11-11 |