| NPI | 1144757469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY LYNN FRESHOUR Practice Administrator 419-592-9956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 30022360) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2017-06-12 |