| NPI | 1023201175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRINODA RADCLIFFE Owner 219-880-1430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010399A) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2008-07-25 |