| NPI | 1538434105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRICE TALLEY Clinical Administrator 614-764-2845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 18954) |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2012-03-15 |