| NPI | 1710366323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK E. WOHLFORD Owner 812-401-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12009501A) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2015-05-28 |