| NPI | 1811381320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW GENE MOY Member 240-286-4145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13375) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 07832) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2015-03-23 |