| NPI | 1982476057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JACOMINO-BARNES Dir. Of Credentialing & Enrollment 800-277-3633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2024-02-16 |