| NPI | 1043727548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES BIENEMAN Owner 574-807-2083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 201891) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 202272) |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2018-01-05 |