| NPI | 1679629828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISHA PATRICE BRUNEY JUDD Owner 410-884-5833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13389) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2016-08-30 |