| NPI | 1609938976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN D GAGNON Owner 316-722-0800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 6850) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2010-02-17 |