| NPI | 1851517825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS HORNING DETWILER Owner Dentist 732-345-8460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ DI011304) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |