| NPI | 1760792766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH A ILACQUA Owner 610-275-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS022706L) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS019424L) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS022786L) | |
| Enumeration Date | 2010-10-12 |
| Last Update Date | 2010-10-12 |