| NPI | 1215406053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAYTON THOMAS CRAIG CEO 765-335-6694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2018-11-23 |
| Last Update Date | 2018-11-23 |