| NPI | 1649391582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MAY Financial COO Rdinator 814-835-3888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: PA DS026417L) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: PA DS027002L) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |