| NPI | 1568670537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER D MARTIN Owner 308-237-5853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |