| NPI | 1417008947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMORY WALLACE BRYAN President 260-485-9142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 54000568A) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-08-22 |