| NPI | 1144308586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW M. GAST Owner 419-522-1837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 19571) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: 12647) |
| 1223P0700X Dentist, Prosthodontics (Licence: OH 21053) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-08-22 |