| NPI | 1487459210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY WANA JOSEPH Pediatric Dentist / Owner 857-200-3312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-02-17 |