| NPI | 1083890933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA D GRAY Office Administrator 317-491-0188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12009586) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2008-01-10 |