| NPI | 1003356973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDY LYNN FISHER Practice Administrator 317-770-1050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12009126) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2017-03-21 |