| NPI | 1700803145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA J GLADIS Surg Asst 814-266-2190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS034161L) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2017-04-10 |