| NPI | 1326298456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY LYNN RUSSELL Practice Manager 614-451-1110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 12953) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2008-09-25 |