| NPI | 1689859589 |
|---|---|
| Doing Business As | GREAT LAKES JAW AND IMPLANT SURGERY CENTER |
| Entity Type | Organization |
| Authorized Contact | JOHN MASCARO President 440-946-2247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2010-06-16 |