| NPI | 1679222343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLY MARIE JACOBS Chief Clinical Director 302-299-5617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2022-03-21 |