| NPI | 1871305987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN UTTERBACK Owner 330-510-2585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2025-01-24 |
| Last Update Date | 2025-08-04 |