| NPI | 1104134881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN D BASOM Owner/Dentist 740-775-8050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30022613) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2010-09-16 |