| NPI | 1245788066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIMEE JOHNSON Office Manager 219-322-5090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12009030a) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2016-09-21 |