| NPI | 1548452097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA RADER Insurance Manager 215-946-3655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: PA DS018685L) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2007-08-17 |