| NPI | 1790359370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAITH ANN HAUPT Business Office Manager 219-985-3133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2021-05-18 |