| NPI | 1356361679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE EDLEY Office Manager 317-596-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010202) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |