| NPI | 1821556721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK S GOLDSTEIN Owner 215-815-0130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-03-10 |
| Last Update Date | 2019-03-10 |