| NPI | 1811064215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS JOHN KOSEK President 574-232-2992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009873) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |