| NPI | 1225141948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN SELBY BROKLOFF Owner 330-668-1001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 20982) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-08-22 |