| NPI | 1851564579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK ALLEN WHITTAKER Pediatric Dentist 419-352-3527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30 012369) |
| Enumeration Date | 2008-04-03 |
| Last Update Date | 2008-04-03 |