NPI: 1588708937 · LOGANSPORT, IN 46947 · General Practice Dentistry · NPI assigned 02/19/2007
| Authorized Official | GORIS, JACK (PRESIDENT) |
| NPI Enumeration Date | 02/19/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 16 | $135.48 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 16 | 13 | $135.48 |