| NPI | 1760449425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS O. PRUSACK President 610-821-8021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS18393L) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2020-08-22 |