| NPI | 1689779605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD LOUDEN BAUER President 330-856-5711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OH 30022050) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |