| NPI | 1477881290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMENICK COLETTI President 410-997-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D0060424) |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2009-12-07 |