| NPI | 1881783702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE MANCUSO Office Manager 215-886-8866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: PA DS-020748-L) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-01-21 |