| NPI | 1215632963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUKE BAUSERMAN Owner 740-607-1529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2024-01-28 |