| NPI | 1760568307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD WAYNE WALTERS President Owner 574-722-5313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12008831) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2011-02-25 |