| NPI | 1841569126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY R FRY Owner 913-469-9191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 60358) |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2011-12-15 |