| NPI | 1245592112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARIN M BACH Owner 800-996-7352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SD M936) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2012-07-09 |