| NPI | 1669554606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY J JACOBS Office Manager 219-662-9932 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009160) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-08-22 |