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 |