| NPI | 1376617126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIOTT JONATHAN GRAY President 410-749-0108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 12030) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 10353) |
| 122300000X Dentist (Licence: MD 4993) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2020-08-22 |