| NPI | 1790849313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS L CHURCH President 765-552-0211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12007767A) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-08-22 |