| NPI | 1154693752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NISSA MCCONNELL Owner/Dentist 812-476-3002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IN 12011723A) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |