| NPI | 1780186080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE MARLOW Credentialing Supervisor 724-698-2119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021424) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2018-03-02 |