| NPI | 1912049115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES G SHEA Owner 814-535-7888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS-018700-L) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2013-09-19 |