| NPI | 1356597603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE LYNAE DAVIDSON Dentist 317-849-9961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010695A) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2008-08-18 |