| NPI | 1265168744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY HARTMAN Hr Manager 765-613-0740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-07-27 |