| NPI | 1487922456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY WAYNE PAMPEL Owner 219-987-5733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12006974) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2011-12-06 |