| NPI | 1538576921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILYA IMYANITOV Director Of Business Operations 215-268-3344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS027760L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS027760L) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2014-07-17 |