| NPI | 1912277963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOATAZ MOHAMMED SHABAN Manager 862-588-6574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MA DN22158) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2012-01-09 |