| NPI | 1316089139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KURT FOLKE Doctor 219-465-6111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IN 12009468) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: IN 12009505) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |