| 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 |