| NPI | 1770009474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL D. FULLER President 330-807-4128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30-023412) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2017-08-15 |