| NPI | 1649316183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L ICZKOVITZ President 260-484-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 16892) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2009-03-26 |