| NPI | 1215219084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUKUKA KAPILIKISHA Owner 219-671-3754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011216a) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2011-09-16 |