| NPI | 1164530259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JOSEPH HEENAN President 419-693-4712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 17029) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2007-10-02 |