| NPI | 1104039510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN ELISE GASSOWAY President 219-938-2875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12007149) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |