| NPI | 1124110457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY ALLAN MCDONALD CEO Pres 937-748-2220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 18367) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D8552) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-22 |