| NPI | 1073656740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY DIANN MAPLE Owner 574-753-4717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010584A) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2007-07-25 |