| NPI | 1639501273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | L. GARY PAINTER Owner 260-486-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12008216A) |
| Additional Taxonomies | 122300000X Dentist (Licence: 12011943A) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2013-08-06 |