| NPI | 1366999070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH FRIED President 219-980-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12009827A) |
| Enumeration Date | 2016-09-10 |
| Last Update Date | 2016-09-10 |