| NPI | 1699242024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE DEBRA BAALS Operations Manager 856-381-7196 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2018-10-24 |