| NPI | 1609528728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATH WALLACE Owner 419-966-8006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2024-07-09 |