| NPI | 1942694583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENT TUCKER President 419-680-0023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OH 30-02437) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2015-03-20 |