| NPI | 1871123984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE COLE VP Insurance Plan Management 419-553-1509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2020-01-17 |