| NPI | 1861788945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA QUINTEROS Credentialing 724-901-1964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223G0001X Dentist, General Practice | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology | |
| 122400000X Denturist | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2024-03-25 |