| NPI | 1669965521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISH HOWER Credentialing Manager 302-500-2042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-06-14 |