| NPI | 1205224433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN FUSON PHILLIPS Member 317-872-7272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: IN 12010493A) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2014-12-22 |