| NPI | 1598872103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE JAY PODHOUSER Dmd Abo 207-772-5487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-08-22 |