| NPI | 1346258167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA GUADALUPE FLETES President 219-922-7945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009619) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |