| NPI | 1255648788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIRUTH FERRIS Front Office Manager 317-883-3368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12010147A) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2010-09-03 |