| NPI | 1619004108 |
|---|---|
| Other Name | DENTAL OFFICE |
| Entity Type | Organization |
| Authorized Contact | TYRUS G MONTGOMERY Dentist 301-877-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-08-22 |