| NPI | 1790710325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN LYNN BAST Office Manager 610-374-4093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS-017990-L) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS026002-L) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS024152-L) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS-017170-L) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2009-01-12 |