| NPI | 1518672153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HYE PARK Owner 301-395-8578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2023-09-11 |