| NPI | 1932440898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM MARK SHIDELER Dds 219-462-7391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12007898) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2013-03-01 |