| NPI | 1740382928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD ARDEN FANTUZZO Owner Dentist 765-457-8359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IN 12010681A) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-08-22 |