NPI | 1366929820 |
---|---|
Entity Type | Organization |
Authorized Contact | BRENT A VAN HALA Dentist 330-929-7344 |
Organization Subpart ? | No |
Primary Taxonomy | 305S00000X Point of Service (Licence: OH 30022586) |
Additional Taxonomies | 305S00000X Point of Service |
Enumeration Date | 2018-07-26 |
Last Update Date | 2018-07-26 |