| NPI | 1003837972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL PORTER President 317-842-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12007054A) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2020-08-22 |