| NPI | 1871628370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD FREDERICK Sole Proprietor 570-829-2691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA 19534-L) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2020-08-22 |