| NPI | 1003306259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALIE ATKINSON Dentist 574-360-6461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12011661A) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2018-05-14 |