| NPI | 1730990821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVORY HANCOCK Owner 202-621-8862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |