| NPI | 1588708937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK E. GORIS President 574-753-4542 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12008389) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2020-08-22 |