| NPI | 1235575499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICE JEAN PHILLIPS Personal Respentative 812-342-9986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12007403) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2013-05-15 |