| NPI | 1043513823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN B VALESANO Single Member Owner 219-322-3418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12008156A) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2010-12-16 |