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 |