| NPI | 1811216062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN GUNTSADZE Manager 267-901-9817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS031318-L) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2010-05-27 |