| NPI | 1972085306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE ANDERSON Executive Operations Assistant 857-928-2036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2018-09-01 |
| Last Update Date | 2018-09-01 |