| NPI | 1487877874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRON KENNETH BIDDLE Treasurer 814-946-8189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 292200000X Dental Laboratory |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |