| NPI | 1962964668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD D'AVANZO Delegated Representative 908-231-1860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2019-06-11 |