| NPI | 1720968639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA QUINTEROS Credentialing 724-901-1964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-09-03 |