| NPI | 1720447444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD ALLEN CLABAUGH Manager 620-931-7560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NE 7121) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2016-02-23 |