| NPI | 1215477088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS MICHAEL PEDAVOLI Owner/Dentist 574-936-2527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12008862A) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2017-02-27 |