NPI | 1790816817 |
---|---|
Entity Type | Organization |
Authorized Contact | KRISTI OUDERKIRK-BOCK Owner 712-263-5615 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 07912) |
Enumeration Date | 2007-03-08 |
Last Update Date | 2025-04-04 |