| NPI | 1386966059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN M GRANDISON President 302-222-8106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: DE G1-0001161) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: DE G4-0001201) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-02-23 |