| NPI | 1649445198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY WHEELER Credentialing COO Rdinator 913-800-6952 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30021038) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2017-04-12 |