Organization
PARK AND SCORNAVACA
Active
Organization
PARK AND SCORNAVACA
Active
Other names
Keystone Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN T MOORE (GENERAL MANAGER)
(302) 562-0060
Entity
Organization
Contact information
Practice address
9727 GREENSIDE DR STE 102, COCKEYSVILLE, MD 21030-5000
(410) 667-6404
Mailing address
1250 PEOPLES PLZ, NEWARK, DE 19702-5701
(302) 836-5072
(302) 836-2690
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
03/04/2024
Last updated
03/04/2024
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