NPI | 1598133514 |
---|---|
Entity Type | Organization |
Authorized Contact | VALERIE PECKOSH Owner 563-582-1478 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: IA 08006) |
Additional Taxonomies | 122300000X Dentist (Licence: IA 08808) |
Enumeration Date | 2015-09-08 |
Last Update Date | 2015-09-29 |