| NPI | 1013526078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE CORNWELL Treasurer/Cpa 740-707-7838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2020-07-27 |