| NPI | 1699260968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL FENLON Business Manager 410-377-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MD 14912) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2024-11-19 |