| NPI | 1790159119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE COOPER Member 937-426-5411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OH 30023136) |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2016-05-03 |