| NPI | 1013375641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY LYNNE GIBSON Insurance COO Rdinator 419-882-4510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 16671) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2016-03-16 |