| NPI | 1699133470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA WICKE Regional VP 732-610-8265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 0355621) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2016-02-08 |