| NPI | 1750450052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS L CUELLAR President 219-548-2322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12008232A) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2020-08-22 |