| NPI | 1740548015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY STEVEN BENSON Owner 219-879-8710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: IN 12011706A) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2012-04-24 |