| NPI | 1285778712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA ALAN CLARK Officer 614-268-4460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30022400) |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2020-08-22 |