| 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 |