| NPI | 1013642107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL DORRIS Insurance Coordinator 219-462-9599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2022-07-21 |