| NPI | 1720526130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISUKE WADA Director Chair Of Periodontology 215-707-7667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: VA 0401414955) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2017-02-06 |