| NPI | 1558416883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L ICZKOVITZ President 260-484-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 54000677) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2009-03-26 |