| NPI | 1104950492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD J. SHAW President 574-936-8787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010465A) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |