| NPI | 1962857573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBEKAH BREVARD Oral Surgeon 609-385-7843 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NJ 22DIO2212104) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2016-05-02 |