| NPI | 1821180852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE MOON Office Manager 410-679-2523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MD 11028) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MD 4843) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-22 |