| NPI | 1003104043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMMAR C. LOULY President 317-869-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IN 12009247A) |
| 1223P0700X Dentist, Prosthodontics | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2023-05-25 |