| NPI | 1861861254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND GORDON KLOCKOW President 219-869-1097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 54000437A) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |