| NPI | 1801300082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS PHILLIP JUDD Dentist 574-533-7621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12011153A) |
| Enumeration Date | 2017-11-26 |
| Last Update Date | 2017-11-27 |