| NPI | 1841341591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE NISTA Acct 3024-754-7102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-22 |