NPI | 1518040054 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHAEL J HAYDUK President Owner 219-872-3232 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IN 12008530) |
Enumeration Date | 2006-10-20 |
Last Update Date | 2020-08-22 |