| NPI | 1437611803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BART PALMISANO Secretary 723-752-2559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2023-02-02 |