| NPI | 1841318458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA L CLINTON Office Manager 219-926-5445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010569A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12009842) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2008-05-06 |