NPI | 1194054940 |
---|---|
Entity Type | Organization |
Authorized Contact | CONRAD C THEISS Periodontist 808-877-3605 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GU DT0971) |
Enumeration Date | 2009-12-08 |
Last Update Date | 2009-12-08 |