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 |