| NPI | 1255411542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J. ROBERT HALL President/Oral Surgeon 765-966-7537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 54000188A) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-08-22 |