| NPI | 1629126214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVON B. MOULDEN Billing Specialist 240-348-1245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 8270) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-22 |