| NPI | 1568813640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES W BARTHOLOMEW Practice Owner 765-453-0291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12009183B) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2016-06-29 |