| NPI | 1477786283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK O GRABER Dentist 1812-386-6150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IN 12011289A) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2009-08-26 |