| NPI | 1326443912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEOFFREY LOUIS GLOGAS Member/President 260-450-4579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12010658A) |
| Enumeration Date | 2014-10-26 |
| Last Update Date | 2014-10-26 |