| NPI | 1619461639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA MCMULLIN President 609-915-9087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21820) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: FL 21820) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2018-06-22 |