| NPI | 1326316746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRAVEEN KUMAR GAJENDRAREDDY Member/ Manager 614-657-8312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021.002403) |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2011-12-13 |