NPI | 1932210010 |
---|---|
Entity Type | Organization |
Authorized Contact | HOWARD ERIC STEVENSON Secretary 219-462-9599 |
Organization Subpart ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12007573A) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12008865A) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2020-08-22 |