| NPI | 1588759609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL DAVID STASTNY Owner 513-984-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OH 30-1-8892) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2008-03-04 |