| NPI | 1508210857 |
|---|---|
| Former Legal Business Name | PARK HEIGHTS DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | DMITRY NOVA President 443-465-2047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 11190) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16079) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2016-04-22 |