| NPI | 1023233459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY HARTMAN Personnel Director 765-662-0018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12010651A) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2020-08-22 |