| NPI | 1255402665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT E WALL Owner 812-265-5962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12007187) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2020-08-22 |