| NPI | 1649487752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN W. RASMUSSEN Pres CEO 765-362-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IN 12008817A) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |