| NPI | 1982411088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON BERGDOLL President, Orthodontist 260-338-2643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-12-12 |
| Last Update Date | 2024-12-12 |