| NPI | 1962784454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES LAWRENCE WILSON President 440-442-5990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 16812) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2011-09-12 |