| NPI | 1205380888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW W. MATTSON Sole Proprietor 330-758-0536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30024504) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2016-08-11 |