| NPI | 1336675784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM M TIMOCK Owner 913-568-1275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 10298) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 9259) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2017-05-04 |