| NPI | 1134100902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL L WOLF Officer 219-322-0501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 54000342A) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2007-08-28 |