| NPI | 1902839996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRET R FRYE Owner 740-374-0123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 19744) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-10-09 |