| NPI | 1538468475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE MARIE RAY President 814-308-9504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS035437) |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2012-02-07 |