| NPI | 1568706091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE DEAN BOGAN Owner/Sole Member 740-548-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-022770) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2021-04-26 |