| NPI | 1912569492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA HALE Manager 260-482-3759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2023-05-01 |