| NPI | 1720220015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL DORRIS Insurance COO Rdinator 219-462-9599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2021-07-07 |