| NPI | 1760657811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ALLAN MECLOSKY Owner 937-748-9240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30018831) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |