| NPI | 1245691492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY J BACKUS Treasurer 419-476-1484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: OH 18187) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2016-03-16 |