| NPI | 1376684894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL JAMES CHALLGREN President 765-446-9606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12007766A) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2009-01-28 |