| NPI | 1063904100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN BEADLE Owner/Dentist 317-709-2318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: IN 12010865A) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-06-05 |