| NPI | 1174633978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER L PEDERSEN Financial Manager 260-925-6094 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 7320) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |