| NPI | 1912007113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW ALAN PETERSON Owner 419-422-7640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-022192) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-08-22 |