| 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 |