| NPI | 1740551167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS CHASE CORNILS Owner/Dentist 765-914-5089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12011436A) |
| Enumeration Date | 2012-01-17 |
| Last Update Date | 2012-01-17 |