| NPI | 1518329614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLIE PARK President 301-525-9398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MD 16129) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2016-03-28 |