| NPI | 1831577717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER JENTES MCILVAINE Sole Member 330-414-4083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-023708) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2015-05-12 |