| NPI | 1598781106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L. ICZKOVITZ President 260-484-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 54000677) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2010-10-12 |