| NPI | 1972685238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT ANTHONY HENRIKSON President 765-807-0230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 1201055A) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-08-22 |