| NPI | 1518352939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN GREGORY INMAN VP Fiscal Affairs/CFO 814-868-8258 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2023-05-24 |