| NPI | 1699140202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP W WALLACE Owner 440-946-5484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.016266) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2015-12-08 |