| 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 |