| NPI | 1649140799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY PANCKO Member 609-256-1702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2025-11-05 |
| Last Update Date | 2025-11-05 |