| NPI | 1588418677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY KORWIN Owner 848-459-2584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2025-08-05 |