| NPI | 1407245749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA M CAPOBIANCO Member 410-569-6700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 12180) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2015-01-09 |