| NPI | 1730640046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD DWINNELLS CEO 330-747-9551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 122300000X Dentist | |
| 124Q00000X Dental Hygienist | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2019-03-28 |