| NPI | 1629659628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY T DORROW Director 410-654-0052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| 1223X2210X Dentist, Orofacial Pain | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-06-10 |