| NPI | 1992963573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY MICHAEL KROE Director Of The Board 410-848-9595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 5003) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2008-05-30 |