| NPI | 1558694117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN M. BLAKE Owner/President 712-362-5454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 06008) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2009-09-15 |