| NPI | 1508169467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHACHINDRA BAHADUR Owner 319-390-1400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 8606) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2010-12-15 |