NPI | 1760050736 |
---|---|
Entity Type | Organization |
Authorized Contact | DEREK LUDOVIT VAJDA President 219-789-8308 |
Organization Subpart ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
Enumeration Date | 2021-06-15 |
Last Update Date | 2021-06-15 |