| NPI | 1235291964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES RICHARD WALKER President 765-362-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12006995A) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2020-08-22 |