| NPI | 1811295181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN H. TUCKER Owner 814-836-7777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS023159L) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2011-10-07 |