| NPI | 1700494499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN MOHAN GORDON Orthodontist 267-360-0777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-07-19 |
| Last Update Date | 2020-07-19 |