| NPI | 1922849843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLYN HODGES Owner 610-999-7008 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-06-04 |
| Last Update Date | 2024-06-04 |