| NPI | 1114007838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOSEPH DEADY Pres 812-232-2108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: IN 12006188) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-08-22 |