| NPI | 1023526852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSCAR G GONZALEZ Director Of Operations 219-465-8627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2020-08-20 |