| NPI | 1093164535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE MICHELLE SCHAUB Owner/President 317-884-8633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12012473A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12007400A) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-06-06 |