| NPI | 1912152430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROMESH NALLIAH Associate Dean For Patient Services 888-707-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223P0300X Dentist Periodontics | |
| 1223P0700X Dentist Prosthodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X0008X Dentist Oral and Maxillofacial Radiology | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2021-09-03 |