| NPI | 1356663025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED H SIMMONS Owner 812-232-1138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: IN 12006984) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-02-23 |