| NPI | 1376769315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN WYNN Member 513-922-4221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 15596) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |