| NPI | 1710739594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY PANCKO Member 609-256-1702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2025-11-05 |