| NPI | 1134844517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TY JUSTICE Director, Credentialing 513-808-4984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist General Practice | |
| Enumeration Date | 2022-10-07 |
| Last Update Date | 2023-05-25 |