| NPI | 1861644718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY M.C. KWON Dds 574-247-2521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011206A) |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2008-10-22 |