| NPI | 1427522945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE LYNN TERESE-KOCH Chair Of The Dept Of Dental Educ 629-802-3221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-01-17 |