| NPI | 1912206970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHI LE Credentialing Specialist 215-550-7186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS-029417-L) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2011-03-16 |