| NPI | 1508077595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY ROBERT BRYANT Owner 574-264-4161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009531) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |