| NPI | 1922167188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT E MUTTON Owner 260-432-3459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12008127) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12010298A) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12009199) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |