| NPI | 1417080797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEWIS A. WILK Owner 570-421-3512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA 018990-L) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2010-08-05 |