| NPI | 1194919217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA L BLACK Office Manager 330-678-9942 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 12449) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2007-08-31 |