| NPI | 1750660221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES GABRIEL POPOVICH CEO 219-663-0252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12010460A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12006634) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2011-08-15 |