| NPI | 1124121793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA BACON Owner 317-848-1771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 54001033A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12009028) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2020-08-22 |