| NPI | 1629583943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BYRON BONEBREAK Owner 410-381-1077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MD 14232) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MD 6368) |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2018-03-17 |