NPI | 1982454310 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHELLE JACOMINO-BARNES Director Credentialing & Enrollment 800-277-3633 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2024-03-26 |
Last Update Date | 2024-03-26 |