| NPI | 1841997871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHI LE Credentialing Manager 267-575-2321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2023-02-09 |