| NPI | 1992865612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONTE YSIDRO Business Manager 316-788-2118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: KS 60024) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |