| NPI | 1174530950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANINE MARIE GREEN Owner 765-289-1578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 1200-9865) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 1200-6019) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-08-22 |