| NPI | 1326762550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETR ALEXANDER VAUGHAN Owner/President 937-245-0390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2022-09-30 |
| Last Update Date | 2022-09-30 |