NPI | 1194295600 |
---|---|
Entity Type | Organization |
Authorized Contact | JACK E NICEWANDER Partner 317-999-9977 |
Organization Subpart ? | No |
Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
Additional Taxonomies | 122300000X Dentist |
Enumeration Date | 2018-11-27 |
Last Update Date | 2020-04-09 |