| NPI | 1467931790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAJ PATEL Dentist 267-392-5878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS038462) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2019-11-12 |