| NPI | 1629490131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT HERBERT FREDRICKSON Owner 570-326-1481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DSD17415L) |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2014-01-17 |