| NPI | 1043618457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA HUBBARD District Manager 317-773-5833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2014-12-17 |