| NPI | 1649422460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRYL LEO MABRA President 937-324-0095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 16529) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2008-10-13 |