| NPI | 1912176686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN SCOTT BURKE President 219-662-9932 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12009850) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-02-26 |