| NPI | 1245382068 |
|---|---|
| Doing Business As | BEAVERCREEK PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | GORDON W WOMMACK Owner 937-426-2653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 17287) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2008-07-22 |