| NPI | 1992371462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REED M FALDET Owner 641-228-1803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2021-07-06 |