| NPI | 1972859189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER ALLEN GILLIN CEO 410-643-8110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 7389) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2012-07-25 |