| NPI | 1265807861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES W HEATON Manager 614-905-6192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 8303) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 2730) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2015-12-08 |