| NPI | 1285933788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE LYNN ULICHNEY Credentialing Manager 440-345-9068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 20396) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2011-03-23 |