| NPI | 1124440417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF SCOTT VAN KIRK President, General Dentist 216-394-3140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9848) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |