| NPI | 1073819041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLAN L. REID President 812-471-9926 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: IN 12008873A) |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2011-02-08 |