| NPI | 1073643854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIGID M LARK Bookkeeper 419-824-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.017159) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |