| NPI | 1134521404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES HAWKINS Owner 740-455-6286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 1821121401) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-10-09 |