| NPI | 1912067349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY ZAK Clinic Manager 219-980-6772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: IN 0) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2022-07-21 |