| NPI | 1972128858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRAYSON JOHN BURGARDT Member, Manager, And Employee 620-260-5655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-07-01 |