| NPI | 1235256124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD R HENDRICKSON Owner 419-289-3325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30-01-6177) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |