| NPI | 1245619956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN A DELORIA Dentist 765-342-8435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009312) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |