| NPI | 1720420532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BATTISTA FONTANA Manager 302-734-1950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: DE G1-0001312) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |