| NPI | 1992237085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI LUTHER CFO 765-751-2795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IN 12009088A) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2017-03-29 |