| NPI | 1316064793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA WILLIS Office Manager 765-453-2619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IN 12009605A) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |