| NPI | 1760762108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONT L. ANNIS Secretary 574-233-7266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12009908 A) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IN 12007912 A) |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2021-01-08 |