| NPI | 1669856753 |
|---|---|
| Former Legal Business Name | MAIDEN CREEK FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ASHALATHA KANCHARLA Owner 484-366-3875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS038394) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |