| NPI | 1336568351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAMROW Member 267-970-0572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6192-15) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2014-04-08 |