| NPI | 1740713163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN BLACK Owner/Dentist 614-805-4702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30291) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2017-04-04 |