| NPI | 1962875286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE LUBARSKY Office Manager 574-522-0156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IN 12009361) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12009361) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2017-01-11 |