| NPI | 1700130630 |
|---|---|
| Doing Business As | MY ORTHODONTIST |
| Entity Type | Organization |
| Authorized Contact | LISA A RADER Insurance Manager 215-750-2254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS018685L) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-10-30 |