| NPI | 1619263522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN MONTGOMERY Residency COO Rdinator 215-707-1020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2022-07-21 |