| NPI | 1134496060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA NELSON Finance Director 765-455-0085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12007486) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2024-03-20 |