| NPI | 1376611673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES IRWIN MATIA Owner 330-264-5851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 30016314) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2008-07-29 |