| NPI | 1689628604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADFORD J. PORTER President 856-596-9099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ DI14482) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2016-08-16 |