| NPI | 1043669583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT CREWS COO 330-951-9153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 9700) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-06-06 |