| NPI | 1912753583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZ BRISLEY Credentialing Manager 440-265-0627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-04-25 |
| Last Update Date | 2024-04-25 |