| NPI | 1033620117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOHETE YOHANNES HENDRIX President/Member 812-945-5533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IN 12011079A) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-11-26 |