| NPI | 1013066448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SAMUEL PEREZ President 219-836-5787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009775) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-22 |