| NPI | 1073840393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA ELROD Dentist 317-257-3368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010357A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12007547A) |
| 1223G0001X Dentist, General Practice (Licence: IN 12010049A) | |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2009-11-06 |