| NPI | 1528399128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN KEITH DAVIS Owner 419-423-4011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OH 30021838) |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2013-09-05 |