| NPI | 1821270919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE M SHIRER President 765-742-4944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IN 12010070A) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2007-11-29 |