| NPI | 1942977491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHI LE Credentialing Contracts Manager 267-575-2321 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2021-08-24 |