| NPI | 1780997320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER SULPOVAR President 2153-394-5558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: PA DS035501) |
| Enumeration Date | 2010-07-25 |
| Last Update Date | 2010-07-25 |