| NPI | 1346752011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE T. KINNEY Owner 317-575-1120 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12008106A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012314A) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2017-11-02 |