| NPI | 1841458916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN J BALVICH President 219-866-8110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IN 12009540A) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2008-05-27 |