| NPI | 1811490055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSCAR GEOVANNI GONZALEZ Director Of Operations 219-465-8627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019021104) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2018-03-14 |