| NPI | 1740328939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK BRANDON GRAVES Dentist 215-242-0670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS025356L) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-08-22 |