| NPI | 1073659884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON C HENIZE Office Administrator 419-562-0981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 17796) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-08-22 |