| NPI | 1376631101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN DECARLO VP Finance 267-362-5869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-09-24 |