| NPI | 1316051600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY FRIEDMAN Owner President 317-852-1446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12010164A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12009280) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-09-06 |