| NPI | 1104208594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLIFFORD W MOORE Owner 419-603-0236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OH 30.023482) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2015-06-23 |