| NPI | 1366558546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ANTHONY GORDON President 219-322-1929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 54001287A) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-12-04 |