| NPI | 1386813533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT C GANO Dentist 269-373-1999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2022-11-16 |