| NPI | 1972884047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRAH MICHELLE LARRABEE Manager 765-412-2469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN DS0000009242) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2011-09-02 |