| NPI | 1639774128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRANATHI REDDY Vice President 215-491-2139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2022-02-15 |