| NPI | 1093250151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIELLE WISSMAN Office Manager 260-489-0001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2022-02-22 |