| NPI | 1710102520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA L. CLARK Manager 301-680-9666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 13622) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 11326) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |