| NPI | 1508951773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICK SUNDIAM Credentialing Operations Lead 302-495-5160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2026-08-07 |