| 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 |