| NPI | 1710580600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH HARRISON Manager 260-747-4747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-11-21 |
| Last Update Date | 2020-11-21 |