| NPI | 1619091196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY KANNER Treasurer 215-757-1574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA Ds017625L) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2008-04-03 |