| NPI | 1407223613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAXWELL WHITE Owner 316-250-7757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: KS 60967) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60967) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |