| NPI | 1346309374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD A. THOMPSON President 765-453-5444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: IN 12008623A) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |