| NPI | 1124068911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE E CARNES Owner 317-241-9876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12007140) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2020-08-22 |