| NPI | 1922017169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD ANDREW EVANSECK Dentist 765-664-2115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009660) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-08-22 |