| NPI | 1922896646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IJEOMA TAGBO Member 410-725-8373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2025-04-30 |
| Last Update Date | 2025-04-30 |