| NPI | 1194891911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JOSEPH KOLOSIONEK President 330-650-4558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 18058) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 18142) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2020-08-22 |